Lancet

Low-income and middle-income countries (LMICs) host nearly 85% of the world's population and bear a disproportionate burden of critical illness. Yet, knowledge generation and dissemination in critical care remain dominated by academics from high-income countries (HICs). A key tool of this dominance is medical journals. The structural biases within the current publishing system prioritise the visibility of work from HIC-based academics, marginalising contributions from LMICs.1 This academic divide has historical roots in colonialism.

We read with interest the study by Peter A Campochiaro and colleagues on RGX-314 for neovascular age-related macular degeneration (AMD),1 which suggests that gene therapy could reduce the need for frequent intravitreal anti-vascular endothelial growth factor (VEGF) injections. However, some methodological concerns warrant further attention.

We thank Huixun Jia and Xiaodong Sun for their perspective on our study.1 The goals of this first-in-human trial were to identify safe doses of RGX-314 and an optimised protocol for advanced studies. Doses in cohorts 1 and 2 were very low, resulting in little expression of anti-vascular endothelial growth factor (VEGF) protein, and, reassuringly, supplemental anti-VEGF injections were needed (these cohorts were vector-treated controls). In cohorts 3–5, there was good expression of anti-VEGF protein: most participants had good control of exudation and many of those with persistent exudation did not improve with monthly supplemental injections.

We read with great interest the Article by Victor Tumukunde and colleagues on kangaroo mother care (KMC).1 The authors conducted a meta-analysis pooling the results from the OMWaNA trial with the WHO iKMC trial2 and eKMC trial in The Gambia. We strongly believe this pooling is unjustified because the OMWaNA study is not comparable with the iKMC trial in terms of participants, intervention, comparisons, and outcomes.

We read with considerable interest the Article by Victor Tumukunde and colleagues1 on the effectiveness of kangaroo mother care (KMC) before clinical stabilisation in sub-Saharan Africa. Although we commend the authors for their extensive research, we believe that their findings necessitate a deeper examination of the practicality and universal applicability of KMC in resource-constrained settings.2

We thank these colleagues for their letters regarding our OMWaNA trial.1 First, in response to Harish Chellani and colleagues from WHO's Immediate Kangaroo Mother Care (iKMC) trial,2 we welcome their insights on our meta-analysis pooling neonatal mortality effects of the OMWaNA trial with similar trials in sub-Saharan Africa, where neonatal mortality is highest. This meta-analysis was important in showing a significant relative reduction in 28-day mortality of 14% across the African sites of all three trials to date, with consistency across five of the six sites,1 all lower than the effect at the iKMC Indian site.

Ivonescimab significantly improved PFS compared with pembrolizumab in previously untreated patients with advanced PD-L1 positive non-small cell lung cancer. Therefore, ivonescimab might represent another treatment option in the first-line setting for PD-L1-positive advanced non-small cell lung cancer.

Tuberculosis is a leading cause of death globally. Given the airborne transmission of tuberculosis, anybody can be infected, but people in high-incidence settings are more exposed. Risk of progression to disease is higher in the first years after infection, and in people with undernourishment, immunosuppression, or who smoke, drink alcohol, or have diabetes. Although cough, fever, and weight loss are hallmark symptoms, people with tuberculosis can be asymptomatic, so a high index of suspicion is required.

Dengue virus, a WHO grade 3 emergency, infected over 10 million individuals in 2024. With no population-effective prophylaxis or direct treatment, there is an urgent need for immediate vector control to protect the 3·9 billion individuals at risk globally.1,2

Humanitarian assistance has saved millions of lives, improved public health outcomes, and strengthened communities in crisis.1 From responding to armed conflicts and natural disasters to advancing disease control and poverty reduction, the humanitarian and development sectors have played an indispensable role in reducing suffering worldwide. However, despite these successes, the existing humanitarian system is not fit for purpose in today's rapidly evolving geopolitical landscape of conflict and displacement.

The ceasefire in Gaza presents an opportunity to rebuild and redesign its health system to include long-term sustainability and autonomy. In Gaza, over 90% of homes and schools have been destroyed; hospitals have been reduced to rubble; and medical personnel have been displaced, arrested, and killed. Temporary emergency aid cannot compensate for the structural weaknesses that have long defined Gaza's health sector. The focus must be on creating a system that is more resilient, equitable, and independent of external factors.

Every year, the global malaria community eagerly anticipates the publication by WHO of its updated World Malaria Report, the cornerstone reference on the epidemiology and burden of malaria worldwide. In its latest 2024 version,1 WHO estimated for the year 2023 a total of 263 million cases and 597 000 malaria deaths, confirming the increasing trend in total case numbers (an additional 11 million) documented in 2022, but with a similar number of deaths. Importantly, malaria deaths disproportionately clustered (95%) in the WHO African region, with three-quarters of those deaths in young children.

The USA is at a pivotal moment in climate policy with far-reaching global implications. The Trump administration's rollback of clean energy initiatives, withdrawal from international agreements, and prioritisation of fossil fuels have sent ripples across the globe.1 However, economic forces, legal constraints, and international commitments ensure that climate progress remains resilient.

Nigeria's premier teaching hospital—University College Hospital, Ibadan—has endured over 100 days without electricity.1 The blackout has not only crippled essential health services but has also jeopardised the training of future health-care professionals. This unfortunate incident underscores the vulnerabilities in health-care delivery and highlights systemic issues in Nigeria's health-care system.

The unprecedented investment in malaria control since the early 2000s has averted an enormous amount of malaria burden. However, case incidence rates in Africa have flattened, and with a rapidly growing population at risk, the number of P falciparum cases in Africa, and thus globally, is now comparable to levels before the surge of investment. Outside Africa progress against malaria morbidity continued after 2015, but a resurgence of P vivax cases in 2022 underscores the fragility of progress against malaria in the face of climatic shocks.

Al-Walah MA, Donnelly M, Alhusaini AA, Heron N. Evaluating the acceptability of “I'm an Active Hero”: a mixed methods process evaluation of a preschool-based physical activity intervention feasibility trial. Lancet 2024; 404 (suppl): S67 (abstr)—In this Abstract, Neil Heron should have been listed as an author and his affiliations listed as both Queen's University Belfast and Keele University. This correction has been made as of March 4, 2025.